Membership Application

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This application is for program providers. Please enter the following information to apply for membership with Hands on the Land.			*Required Fields

Site Name:	*
Site Link:	*
Agency:	*

First Name:		*
Last Name:		*
Address 1:		*
Address 2:
City:		*
State:		*
Zip Code:		*
E-mail:		*
Phone:
Fax:

Program Description:
Briefly describe the current education programs offered at your site, frequency of programs, and grade levels reached.

Big Picture:*
Briefly describe the natural and cultural resources at your site.

Educational Partners:*
List other community organizations and partnerships associated with your program.

Site Mission and Needs:
What is your site's mission? How can we provide assistance to you so that your mission may be fulfilled? What resources will you require from Hands on the Land?

Please enter the characters above:

Teachers, learn about service learning opportunities and how to become a Take Pride in America School.